Health care search

Scams run rampant during open season.

It’s health insurance “open season,” so I went to a couple of websites to see if we can do better for my wife, Paula, whose Virginia Premier policy has a deductible of $7,100. Her monthly premium next year will be a cool $920. And she’s totally healthy and hardly knows what a doctor is. (Except, of course, she lives with one.)

That was a mistake.

Our phone is in meltdown. I have messages from Debbie, Todd, Jafri, Albert, Krystal, Tiffany, Katy (five times) James, Malique, Lee, Jason, William (twice), Amanda, Anthony ... and on and on. Not to mention the 10 times as many callers who didn’t leave a message.

We are not alone, it seems. Aaron Foss, who runs a spam-blocking service in New York, says spamming is “at epidemic levels at this time of year,” noting they have had a five-fold increase in “intercepts” since health insurance open season started.

“Open season” may make you think about black powder and buckshot, but we’re talking about the frenetic six weeks, starting Nov. 1 and ending Dec. 15, that is the only time most people can sign up for a different health insurance plan. An open season where you and I are the prey.

All these calls and high-pressure sales tactics make me think there must be money to be made—a notion corroborated by presidential candidate Elizabeth Warren, who has said, “The insurance companies last year alone sucked $23 billion in profits out of the health care system.”

How Do You Decide?

Being a doctor, I’m on the inside, to an extent. Still, I find figuring out the best policy incredibly confusing.

It’s gambling, really. You’re pitting the amount of the deductible, co-pay, out-of-pocket maximum and what proportion of doctor visits, hospital admissions, ICU days, ER visits, dental and vision care you need against your monthly premium.

You need a crystal ball to know if you’re going to have any major health care needs. It is like deciding which horse to back and how much to wager.

It is now even more complicated, since President Trump issued an executive order in 2017 to promote “health care choice and competition.” This allowed the sale of so-called “skinny” or “junk” policies with lower premiums which don’t have to fulfill the requirements of the Affordable Care Act.

Those who I’ve talked to who told me they were “qualified insurance agents” seem to push those types of policies hard—and seemed to want me to sign up before I saw the policy.

The advice I have read about these policies is: Beware. They don’t have to cover preexisting conditions and can have out-of-pocket maximums—so when you’re really sick and really need it, it’s, “Oops, you’ve exceeded your maximum.”

Also, these are undermining the ACA.

The idea of the ACA was that everyone would contribute to the insurance pool—there was that “mandate” that some Libertarian-types bridled at. But the idea was wealthy people who needed less health care helped supplement those who needed more.

Now, those people are bailing and going for the skinny policies, so ACA premiums are rising—at

5 percent per year. And the Trump administration has also cut the tax credits that defray the cost of premiums for ACA policies for low-income households—to the tune of $4.26 billion over four years.

A TILTED PLAYING FIELD

The idea that unfettered market forces and private enterprise will result in the best system, I think, has been thoroughly disproved by the health insurance market—and by the industry as a whole.

Or maybe I’m just looking at it wrong. The industry has done a great job in tilting the playing field to its own advantage. Private enterprise has resulted in the best system—it’s just best for the industry, not for the patient.

With some exceptions, the industry is not inclined to maneuver to advantage the patient. The only way we can make that happen is through politicians or legislators taking our side.

Good luck with that.

As I struggle with the nightmare of trying to get my head around the zillion companies, each with a zillion different plans, and the zillion variables, I become even more convinced that local family physician Dr. Jay Brock, with his impassioned jockeying for single-payer health care, is right. It would simplify things, if nothing else.

So I soldier on, bamboozled by the mass of different policies and driven mad because Debbie, Todd, Jafri and their friends just keep calling.

Dr. Patrick Neustatter of Caroline County is the author of “Managing Your Doctor: The Smart Patient’s Guide to Getting Effective Affordable Healthcare.”

Dr. Patrick Neustatter of Caroline County is the author of “Managing Your Doctor: The Smart Patient’s Guide to Getting Effective Affordable Healthcare.”

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